Background: Recent research suggests that posttraumatic stress disorder (PTSD) is associated with altered amygdala and hippocampal resting-state functional connectivity (rsFC). However, less research has examined whether Prolonged Exposure (PE), a first line exposure-based treatment for PTSD, has the potential to alter resting state neural networks. Methods: A total of 24 patients with PTSD and 26 matched trauma-exposed healthy controls (TEHCs) underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. PTSD patients were scanned a second time after completing 10-session PE in which patients narrated a detailed trauma account (imaginal exposure) and confronted trauma reminders (in vivo exposure) to extinguish trauma-related fear responses. TEHC were scanned again following a 10-week waiting period. Seed regions of interest (ROIs) included centromedial amygdala (CMA), basolateral amygdala (BLA), and the hippocampus. Results: Post- versus pretreatment comparisons indicated increased rsFC of the BLA and CMA with the orbitofrontal cortex (OFC), and hippocampus-medial prefrontal cortex (mPFC) among patients with PTSD, but not among TEHC participants. Conclusions: Enhanced amygdala and hippocampus rsFC with prefrontal cortical regions following PE could underlie improved capacity for inhibition and re-evaluation of threat, and heightened memory encoding and retrieval ability, respectively. These findings encourage further investigation of this circuitry as a therapeutic target in PTSD.
|Number of pages||11|
|Journal||Depression and Anxiety|
|State||Published - Oct 2018|
Bibliographical noteFunding Information:
This research was supported by grants R01MH072833 and R01MH105355 from the National Institute of Mental Health (NIMH) (Y.N., Principal Investigator), and the New York State Psychiatric Institute. B.S.-J.’s (MH015144) and A.L.’s (MH020004) work is supported by a T32 grant from the NIMH. L.H.’s work is supported by T32 grant MH096724 from the NIMH. Funding from the Donald D. Harrington Fellows Program supported S.P.’s work.
F.S., J.C.M., and Y.N. are employees of the New York State Psychiatric Institute. J.C.M. has received research support from the Mack Foundation and book royalties from American Psychiatric Publishing, Basic Books, and Oxford University Press. Y.N. has received royalties from Cambridge University Press and Springer, and research support from the Mack Foundation, Stand for the Troops, and the New York Presbyterian Hospital. F.S. has received royalties from Cambridge University Press, Guilford and Uptodate, research support from Forest labs, and honorarium from Elsevier. The authors report no biomedical financial interests or potential conflicts of interest. The authors thank the individuals who contributed to this study: therapists, evaluators, research assistants, volunteers, the personnel of the New York State Psychiatric Institute Anxiety Disorders clinic, and the patients who participated in this treatment study.
© 2018 Wiley Periodicals, Inc.
- prolonged exposure treatment
- resting-state functional connectivity
ASJC Scopus subject areas
- Clinical Psychology
- Psychiatry and Mental health